The Eyes Have It At Shoreline Vision

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For an organization that did not exist before 1996, Shoreline Vision has expanded rapidly in 12 years — much like the advances in the science and technology of eye care.

Shoreline Vision is now one of the major eye clinics in West Michigan, with patients among the shoreline population from Ludington down to Holland. The organization has about 116 employees at four locations, including a medical center in Muskegon dedicated solely to eye surgery, plus offices in Grand Haven, Fremont and North Muskegon.

Altogether, the eight ophthalmologists and three optometrists at Shoreline Vision see 70,000 patients a year. It is a multi-million dollar business that will continue to grow as continuing improvements in medicine and health care extend the average life expectancy.

According to the American Academy of Ophthalmology — which describes itself as "the eye M.D. association" — the prevalence of visual impairments in adults will increase as the average age of the U.S. population increases and as conditions like diabetes increase. Current estimates indicate that 3 percent of Americans age 40 and older are either blind or visually impaired. The public health costs of blindness and vision impairment are estimated at $68 billion annually nationwide.

Dr. Mark Kinziger, a Muskegon ophthalmologist, initiated the formation of the company in 1996. Today his partners are John Oltean, D.O., Kenneth Otto, M.D., Lee Webster, M.D., and Timothy Barron, M.D. It is an equal partnership, with the presidency of the organization rotating to a different partner every three years; Otto is the current president. Executive director of the firm is Chris Grek.

The ophthalmologists on staff at Shoreline Vision strive to stay on top of the rapidly changing science and technology in eye care, as evidenced by Oltean's recent trip to China.

Oltean visited an eye surgery clinic at a university in Shanghai in December "to see how other people do things," he said. He spent a half-day in cataract surgery as an observer. The thing that struck him most about what he saw was the "efficiency at getting done what they had to get done."

For example, one large surgery room was devoted to left eyes, another room to right eyes. A surgeon could work his way down the line of patients, doing just the eye on one side. That saved the time of changing the equipment setup for doing the patient's other eye.

Oltean described what he saw as "very high-quality surgery," but he said the American style of cataract surgery is more focused on patient issues such as comfort. For example, there was no anesthesiologist for the surgery. The eye was numbed, but that was all.

"Here, the patient's first question is, ‘Am I going to be totally out for this?’" said Oltean.

"It seemed like everything they did (in China) was geared toward providing the service — still with quality, but at a minimal cost," he said.

For example, they do not use disposables such as plastic drapes to cover the patient. Oltean said he suspects that the cost of labor in China is still so low that it's cheaper to have people working to wash linens and sterilize equipment rather than use disposables.

As far as the technology in use, there did not seem to be any significant difference between Chinese cataract surgery and American cataract surgery.

"I think we can learn some things from their efficiency," said Oltean. He noted that with the push in America to lower health care costs, "maybe one thing we can try to improve upon is just making things a big more efficient, without sacrificing quality."

During Oltean’s five days in China, the Chinese medical experts were very interested in learning what they could from him, such as the different types of implants used in this country and the new techniques.

But eye surgeons everywhere have to work to stay abreast of new developments in vision care.

Oltean started his practice after finishing his residency in 1994.

"Over those 14 years, there has been an incredible boom of technology as far as vision care goes," he said.

"I think our end goal is, we'd like to be able to correct vision to the point where you can be as independent as you choose of any visual aids" — such as glasses or contacts, he said.

The Shoreline Vision eye surgery center opened in May 2006. During 2007, more than 2,000 cataract surgeries were performed there, according to Jennifer Scofield, the marketing manager. The center also does a lesser number of LASIK surgeries to correct vision problems, now offering blade-free technology. Previously, a blade was used at the start of a LASIK surgery, with a laser completing the surgery. Blade-free LASIK "doesn't even take 15 minutes to see perfect again, without glasses," said Scofield.

Cataract surgery is the replacement of cloudy lens tissue with an intraocular lens (IOL) made of synthetic material, but in the past, most of the time the patient would still need glasses, said Oltean.

Less than two years ago came a breakthrough with new specialty IOLs for cataract surgery. One type of specialty IOL can also correct astigmatism; the other specialty IOL can correct both astigmatism and multi-focal vision deficiencies.

While insurance usually covers cataract surgery, it generally does not cover the specialty lenses that can correct the patient's other vision problems. Oltean said that until about 18 months ago, insurance industry regulations prevented ophthalmologists from offering the specialty lenses, even if the patient was willing to pay out of pocket for the cost above and beyond the standard artificial lens.

Now they can at least offer the specialty lenses, although insurance still does not cover them, said Oltean. The specialty IOL that corrects astigmatism costs about $750 for one lens; the multi-focal specialty IOL costs around $1,750 per lens.

LASIK surgery can cost from $3,500 up to $4,300, said Oltean, and it is not covered by insurance.

Oltean said Shoreline Vision business increases by about 10 percent each year, but some of that growth is absorbed by the addition of more people to the staff and more services. Since LASIK and the specialty IOLs for cataracts are elective surgeries not covered by insurance, a poor economy hurts Shoreline Vision.

"I think a lot of people would love to have LASIK, but when they look at the cost, it's just not in their budget," said Oltean.

At the same time, the rising cost of health care in America is adding to the challenges facing ophthalmologists and optometrists.

"We pretty much get reductions in fee schedules about every year, while our other overhead costs continue to rise," said Oltean. Fee schedules are the amounts the insurance companies will pay for specific procedures. HQX

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